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1.
Med Clin North Am ; 105(4): 783-797, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34059250

RESUMO

This evidence-based review highlights cutaneous infections of bacterial, viral, and fungal origin that are frequently encountered by clinicians in all fields of practice. With a focus on treatment options and management, the scope of this article is to serve as a reference for physicians, regardless of field of specialty, as they encounter these pathogens in clinical practice.


Assuntos
Infecções Bacterianas/patologia , Infecções por Herpesviridae/patologia , Micoses/patologia , Dermatopatias Infecciosas/tratamento farmacológico , Dermatopatias Infecciosas/patologia , Adolescente , Adulto , Infecções Bacterianas/complicações , Infecções Bacterianas/microbiologia , Criança , Pré-Escolar , Ectima/diagnóstico , Ectima/tratamento farmacológico , Erisipela/diagnóstico , Erisipela/tratamento farmacológico , Eritema Multiforme/diagnóstico , Eritema Multiforme/tratamento farmacológico , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/tratamento farmacológico , Foliculite/diagnóstico , Foliculite/tratamento farmacológico , Herpes Genital/diagnóstico , Herpes Genital/tratamento farmacológico , Herpes Labial/diagnóstico , Herpes Labial/tratamento farmacológico , Infecções por Herpesviridae/complicações , Infecções por Herpesviridae/virologia , Humanos , Impetigo/diagnóstico , Impetigo/tratamento farmacológico , Erupção Variceliforme de Kaposi/diagnóstico , Erupção Variceliforme de Kaposi/tratamento farmacológico , Pessoa de Meia-Idade , Micoses/complicações , Micoses/microbiologia , Onicomicose/diagnóstico , Onicomicose/tratamento farmacológico , Padrões de Prática Médica/estatística & dados numéricos , Dermatopatias Infecciosas/microbiologia , Dermatopatias Infecciosas/virologia , Tinha do Couro Cabeludo/diagnóstico , Tinha do Couro Cabeludo/tratamento farmacológico , Adulto Jovem
2.
J Dermatol ; 48(5): 633-637, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33686693

RESUMO

Tinea unguium is a common nail disease caused by dermatophytes. Although direct potassium hydroxide (KOH) microscopy and fungal culture are considered the gold standard for diagnosing this disease, their accuracy is insufficient. A lateral flow immunochromatographic assay (LFIA) kit, using a monoclonal antibody against Trichophyton rubrum, was developed and its sensitivity was recently improved 50% in vitro relative to its earlier version. The present study aimed to validate the clinical utility of this improved LFIA kit for diagnosing tinea unguium in comparison with direct KOH microscopy. A similar trial was simultaneously performed using scale samples from patients with tinea pedis to determine the assay's diagnostic potential. Nail samples, approximately 2 mg in weight, were collected from 112 non-treated tinea unguium patients and 56 non-tinea unguium patients. Samples from 25 tinea pedis patients and 20 non-tinea pedis patients were also collected. The sensitivity and specificity of the LFIA kit for tinea unguium was 84.8% (95/112) (95% confidence interval [CI], 76.8-90.9) and 83.9% (47/56) (95% CI, 71.7-92.4), respectively. The inconsistency rate was 15.5% (26/168) (95% CI, 10.4-21.9). The sensitivity and specificity of the LFIA kit for tinea pedis was 84.0% (21/25) and 100.0% (20/20), respectively. These results suggest that for diagnosing tinea unguium, the LFIA kit is a useful supplement to, but not a replacement for, direct KOH microscopy. For definitive diagnosis of suspected cases, appropriate sampling, repeated examinations, and a combination of diagnostic techniques are essential.


Assuntos
Onicomicose , Arthrodermataceae , Humanos , Imunoensaio , Onicomicose/diagnóstico , Tinha dos Pés , Trichophyton
4.
Pediatr Dermatol ; 38(2): 524-525, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33481262

RESUMO

A healthy 15-year-old girl presented with a total dystrophic nail plate and subungual hyperkeratosis over her left 3rd fingernail. Her 2-year-old shorthair cat had circular erythematous patches of alopecia on the left aspect of its forehead. Fungal culture from the affected nail and her cat both grew Microsporum canis. The girl was treated with terbinafine with clinical and mycological cure.


Assuntos
Onicomicose , Adolescente , Animais , Antifúngicos/uso terapêutico , Gatos , Humanos , Microsporum , Unhas , Onicomicose/diagnóstico , Onicomicose/tratamento farmacológico , Terbinafina
5.
Med Clin North Am ; 105(1): 187-197, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33246518

RESUMO

Primary care providers frequently care for complaints of the hands and feet. Here, the author describes the typical presentations of hand osteoarthritis, carpal tunnel syndrome, ganglion cysts, plantar fasciitis, onychomycosis, and Morton neuroma. Useful physical examination techniques are described. The history and physical examination are usually sufficient to diagnose these conditions without the need for more advanced testing. All of these conditions have evidence-based therapy that can be initiated by the primary care provider. These treatments as well as reasons to refer to a specialist are reviewed.


Assuntos
Doenças do Pé/diagnóstico , Doenças do Pé/terapia , Mãos , Síndrome do Túnel Carpal/diagnóstico , Síndrome do Túnel Carpal/terapia , Fasciíte Plantar/diagnóstico , Fasciíte Plantar/terapia , Cistos Glanglionares/diagnóstico , Cistos Glanglionares/terapia , Articulação da Mão , Humanos , Anamnese , Neuroma Intermetatársico/diagnóstico , Neuroma Intermetatársico/terapia , Onicomicose/diagnóstico , Onicomicose/terapia , Osteoartrite/diagnóstico , Osteoartrite/terapia , Educação de Pacientes como Assunto , Exame Físico , Autogestão
8.
PLoS One ; 15(6): e0234334, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32525908

RESUMO

BACKGROUND: Onychomycosis is the most common nail disorder and is associated with diagnostic challenges. Emerging non-invasive, real-time techniques such as dermoscopy and deep convolutional neural networks have been proposed for the diagnosis of this condition. However, comparative studies of the two tools in the diagnosis of onychomycosis have not previously been conducted. OBJECTIVES: This study evaluated the diagnostic abilities of a deep neural network (http://nail.modelderm.com) and dermoscopic examination in patients with onychomycosis. METHODS: A prospective observational study was performed in patients presenting with dystrophic features in the toenails. Clinical photographs were taken by research assistants, and the ground truth was determined either by direct microscopy using the potassium hydroxide test or by fungal culture. Five board-certified dermatologists determined a diagnosis of onychomycosis using the clinical photographs. The diagnosis was also made using the algorithm and dermoscopic examination. RESULTS: A total of 90 patients (mean age, 55.3; male, 43.3%) assessed between September 2018 and July 2019 were included in the analysis. The detection of onychomycosis using the algorithm (AUC, 0.751; 95% CI, 0.646-0.856) and that by dermoscopy (AUC, 0.755; 95% CI, 0.654-0.855) were seen to be comparable (Delong's test; P = 0.952). The sensitivity and specificity of the algorithm at the operating point were 70.2% and 72.7%, respectively. The sensitivity and specificity of diagnosis by the five dermatologists were 73.0% and 49.7%, respectively. The Youden index of the algorithm (0.429) was also comparable to that of the dermatologists' diagnosis (0.230±0.176; Wilcoxon rank-sum test; P = 0.667). CONCLUSIONS: As a standalone method, the algorithm analyzed photographs taken by non-physician and showed comparable accuracy for the diagnosis of onychomycosis to that made by experienced dermatologists and by dermoscopic examination. Large sample size and world-wide, multicentered studies should be investigated to prove the performance of the algorithm.


Assuntos
Aprendizado Profundo , Dermoscopia , Dermatoses do Pé/diagnóstico , Onicomicose/diagnóstico , Adulto , Algoritmos , Sistemas Computacionais , Dermatologistas , Diagnóstico por Computador , Erros de Diagnóstico , Feminino , Dermatoses do Pé/diagnóstico por imagem , Dermatoses do Pé/microbiologia , Humanos , Hidróxidos , Masculino , Pessoa de Meia-Idade , Técnicas de Tipagem Micológica , Redes Neurais de Computação , Onicomicose/diagnóstico por imagem , Onicomicose/microbiologia , Fotografação , Compostos de Potássio , Valor Preditivo dos Testes , Estudos Prospectivos , Adulto Jovem
9.
Med Mycol J ; 61(2): 17-21, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32475885

RESUMO

Wood's lamp was demonstrated to be useful in three cases of dermatophytoma treated during clinical dermatological practice. Clinical signs of onychomycosis are longitudinal yellow and white striae on the nail plate and are diagnosed by KOH direct microscopic examination. For its treatment, surgical debridement is recommended. Usefulness of the Wood's lamp for diagnosis of tinea capitis caused by Microsporum canis is standard. In the first and second cases, we used Wood's lamp (Woody™) to make a clear margin for debridement of onychomycosis. In the third case, onychomycosis was unsuccessfully treated using topical 5% luliconazole nail solution for 1 year and 10 months with yellow nail discoloration. Under Wood's lamp, we were able to distinguish luliconazole crystal staining from onychomycosis. This method is simple and quick, and useful for nail observation in dermatology clinics.


Assuntos
Dermatologia/métodos , Onicomicose/diagnóstico , Idoso , Humanos , Imidazóis/administração & dosagem , Masculino , Microsporum/patogenicidade , Pessoa de Meia-Idade , Unhas/microbiologia , Unhas/patologia , Onicomicose/tratamento farmacológico , Onicomicose/microbiologia , Onicomicose/patologia , Fatores de Tempo
11.
Infection ; 48(3): 429-434, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32232786

RESUMO

BACKGROUND: Fungal infections of the skin, hair, and nails are the largest and most widespread group of all mycoses. Nannizzia nana is a relatively rare etiological factor of dermatomycosis in humans, as it usually affects animals, e.g. pigs and boars. In addition to the zoophilic nature, there are also reports of the geophilic reservoir of this dermatophyte species. OBJECTIVE: In this study, we present symptomatic infections with N. nana aetiology in humans reported recently in Poland. Interestingly, these cases had a non-specific clinical picture and occurred as skin lesions on the neck and foot as well as onychomycosis of the toenails. From the medical history, the patients had no contact with pigs. METHODS: Diagnostics of these infections was performed with a combination of classical phenotypic and molecular genomic methods. The genomic diversity of the isolates was determined using the MP-PCR method. In vitro antifungal susceptibility tests against itraconazole, ketoconazole, terbinafine and naftifine hydrochloride were also performed. RESULTS: Nannizzia nana has been identified as an etiological factor of dermatomycosis. Moreover, heterogeneity of the genomes was revealed for the obtained strains. In vitro activities of antifungal agents showed that isolates were susceptible to all tested drugs. The patients were treated with oral terbinafine and topical ketoconazole cream, which led to a complete recovery. CONCLUSIONS: In conclusion, the cases studied by us may indicate that the infrequency of N. nana infections may not necessarily be related to the low infectivity of this fungal agent, but they are rather associated with misdiagnosis. Furthermore, N. nana reservoirs should also be sought in soil.


Assuntos
Antifúngicos/uso terapêutico , Arthrodermataceae/isolamento & purificação , Dermatomicoses/diagnóstico , Cetoconazol/uso terapêutico , Administração Oral , Administração Tópica , Adulto , Idoso , Arthrodermataceae/classificação , Dermatomicoses/tratamento farmacológico , Dermatomicoses/microbiologia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Onicomicose/diagnóstico , Onicomicose/tratamento farmacológico , Onicomicose/microbiologia , Microbiologia do Solo , Terbinafina/uso terapêutico , Resultado do Tratamento
12.
J Mycol Med ; 30(1): 100920, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31892498

RESUMO

Onychomycosis is considered a fungal nail infection caused mainly by dermatophytes, yeasts and non-dermatophyte molds including dematiaceous fungi. Onychomycosis caused by non-dermatophyte molds is a health problem in the medical environment as the patients frequently return to outpatient clinics seeking new therapeutic modalities. Here, we report the first case of onychomycosis caused by a black fungus, Neoscytalidium novaehollandiae, in the right hand finger nail of a 52-year-old Iranian female with no history of immunodeficiency and underlying disease. The pattern of nail involvement was recognized as total dystrophic onychomycosis. Examination of nail scrapings with potassium hydroxide revealed brown, septate and branching sub-hyaline to dark-colored hyphae. The black fungus isolated in culture was identified as Neoscytalidium novaehollandiae by molecular analysis. The patient received oral terbinafine plus ciclopirox nail lacquer twice a week and began responding to the treatment three months after initial antifungal therapy. Additional four weeks' use of terbinafine plus ciclopirox nail lacquer completely resolved the clinical manifestations of onychomycosis. After four months, both microscopy and culture were negative.


Assuntos
Ascomicetos , Dermatoses da Mão/microbiologia , Onicomicose/microbiologia , Antifúngicos/uso terapêutico , Ascomicetos/efeitos dos fármacos , Ascomicetos/genética , Ascomicetos/isolamento & purificação , Resistência Microbiana a Medicamentos/efeitos dos fármacos , Feminino , Dermatoses da Mão/diagnóstico , Dermatoses da Mão/tratamento farmacológico , Humanos , Imunocompetência , Irã (Geográfico) , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Técnicas de Diagnóstico Molecular , Técnicas de Tipagem Micológica/métodos , Onicomicose/diagnóstico , Onicomicose/tratamento farmacológico
14.
Arch Dermatol Res ; 312(3): 207-212, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31728627

RESUMO

Diagnosis of onychomycosis requires microbiological studies, which are time-consuming. Dermoscopy is non invasive, easy and coastless method. To evaluate the diagnostic role of dermoscopy in onychomycosis and comparing its findings with microbiological results. Eighty patients with onychomycosis and 40 controls were studied for nail dermoscopic finding, and microbiological examinations in the form of microscopic examination by 20% KOH, Sabouraud dextrose agar (SDA), and HiCrome Candida Differential Agar. 72.5% of the patients were females. Most of the patient were presented with one finger (35%) and two fingers (35%). 85% of the patient were presented clinically with distal lateral subungual onychomycosis followed by total dystrophic onychomycosis (12.5%) and lastly with superficial white onychomycosis (2.5%). 52.5% and 75% of the patients were positive by direct microscopic examination with 20%KOH and SDA, respectively. Dermatophytes isolated from 7.5% of the patient, non-dermatophytes (Aspergillus) was isolated from 2.5%, and 65% had Candida by SDA. C. albicans was the commonest species (75%), followed by C. tropicalis (17.3%), and lastly C. krusei (7.7%). Dermoscopic examinations of patients showed nail spikes, longitudinal striations, and color changes in 75%, 82.5%, and 95%, respectively, with statistically significant P value (P < 0.001). There was significant difference regarding long striations and yellow coloration dermoscopic finding with positive KOH patients. All patients with positive culture showed nail spikes on dermoscopic examination. Dermoscopy is a rapid tool for diagnosis of onychomycosis. Longitudinal striations is the best diagnostic dermoscopic finding. Microbiological test are still needed for accurate and reliable diagnosis.


Assuntos
Aspergillus/fisiologia , Candida/fisiologia , Dermoscopia/métodos , Unhas/patologia , Onicomicose/diagnóstico , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Unhas/microbiologia , Adulto Jovem
15.
Am J Dermatopathol ; 42(2): 133-135, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31503009

RESUMO

Onychomatricoma is a slow-growing, benign neoplasm of the nail matrix with several histological variants. With only 2 cases previously reported, the term "myxoid onychomatricoma" has been used by some authors to describe a rare variant, known to have a fibromixoid component. We present a case of a 51-year-old Caucasian woman with a 1-year history of thickening and discoloration of the right thumbnail, who was initially misdiagnosed as onychomycosis. After performing a magnetic resonance imaging that showed a tumor with several filamentous projections, an onychomatricoma was suspected and a total distal plaque avulsion was performed. Histology revealed a biphasic tumor with an epithelial component and a prominent myxoid stroma. Immunohistochemical staining was then used, confirming the diagnosis. Considering these findings, we believe that our case meets the diagnostic description of "myxoid onychomatricoma" and is, therefore, a new case of this rare histological variant.


Assuntos
Doenças da Unha/patologia , Neoplasias Cutâneas/patologia , Erros de Diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Onicomicose/diagnóstico
17.
Mycoses ; 63(1): 113-118, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31642133

RESUMO

Onychomycosis (OM), has a worldwide prevalence of 5% and 0.5%-5% in India. Trichophyton. rubrum (T rubrum) and T mentagrophytes are the most commonly isolated fungi. As the clinical and mycological characteristics change with time and geographical region; it is important to study the temporal and topographic patterns periodically. The study was conducted to identify the epidemiological and clinico-mycological characteristics of patients with OM attending a tertiary care hospital in Delhi. Hundred patients with clinical diagnosis of OM were recruited. Among these, 88 patients who tested positive for OM on direct microscopy with KOH, culture and/or histopathology with periodic acid-Schiff were included in the study. The clinico-mycological characteristics and risk factors associated with OM were evaluated. OM was more common in males (M:F = 2.5:1). The mean age of patients with OM was 39 ± 15.3 years (SE 1.52) with mean disease duration of 27.6 ± 46.1 months (SE 4.9). Seventeen (19.3%) patients had concomitant diabetes mellitus. The patients displayed mean body mass index (BMI) of 25.67 ± 1.35 kg/sq m. Concurrent dermatophytosis of skin was present in 35 (39.77%) patients. Two feet-one hand syndrome was present in 5 patients. Fingernail involvement without toenail involvement was more common than toenail involvement alone. (43.18% vs 38.63%). Distal and lateral subungual OM (DLSO) was the commonest clinical variant (81.8%). Mycological culture showed growth in 47 (53.40%) patients. Dermatophytes were isolated in majority, that is in 30 (63.82%) patients followed by non-dermatophytic moulds (NDM) in 7 (14.8%) and Candida spp. in the remaining 10 (21.27%) patients.


Assuntos
Unhas/microbiologia , Onicomicose , Adolescente , Adulto , Idoso , Arthrodermataceae/isolamento & purificação , Candida/isolamento & purificação , Estudos Transversais , Diabetes Mellitus , Feminino , Dermatoses do Pé/microbiologia , Dermatoses da Mão/microbiologia , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Unhas/patologia , Onicomicose/diagnóstico , Onicomicose/epidemiologia , Onicomicose/patologia , Prevalência , Fatores de Risco , Centros de Atenção Terciária , Tinha/diagnóstico , Trichophyton/isolamento & purificação , Adulto Jovem
19.
Mycopathologia ; 184(5): 683-689, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31502093

RESUMO

Opportunistic fungal infections of the skin and nail are frequently encountered in human. Recent years have shown increased incidence of fungal infections especially in immunocompromised patients. Onychomycosis in HIV-infected patients is reported to occur in 15-40%, four times more than in the general population. Here, we report a case of fingernail proximal subungual onychomycosis with associated skin infection caused by an opportunistic mold, Aspergillus sydowii, in a HIV positive individual. Isolation of A. sydowii from nail and skin of an immunocompromised person needs accurate identification for successful treatment.


Assuntos
Aspergilose/diagnóstico , Aspergillus/isolamento & purificação , Infecções por HIV/complicações , Dermatoses da Mão/diagnóstico , Hospedeiro Imunocomprometido , Onicomicose/diagnóstico , Adulto , Aspergilose/patologia , Dermatoses da Mão/patologia , Humanos , Masculino , Onicomicose/patologia
20.
BMJ Case Rep ; 12(8)2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31413063

RESUMO

This case report presents a patient who, while undergoing oral isotretinoin therapy for acne vulgaris, developed onychocryptosis and asymptomatic external urethritis. These uncommon adverse events are not well-documented in medical literature. While his urethritis spontaneously resolved, his onychocryptosis symptoms necessitated surgical intervention. This report illustrates both cosmetic and functional adverse effects of isotretinoin and provides insight into the progression of these reactions over time.


Assuntos
Fármacos Dermatológicos/efeitos adversos , Dermatoses do Pé/diagnóstico , Isotretinoína/efeitos adversos , Onicomicose/diagnóstico , Uretrite/diagnóstico , Acne Vulgar/tratamento farmacológico , Administração Oral , Adolescente , Diagnóstico Diferencial , Dermatoses do Pé/induzido quimicamente , Dermatoses do Pé/complicações , Humanos , Masculino , Onicomicose/induzido quimicamente , Onicomicose/complicações , Uretrite/induzido quimicamente , Uretrite/complicações
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